Lyme Carditis and Pacemaker Removal: Two Cases
Lyme carditis can cause serious conduction abnormalities
Two patients received permanent pacemakers during treatment
Both later had successful pacemaker removal
Lyme carditis can lead to cardiac arrhythmias and conduction abnormalities, most commonly atrioventricular (AV) block. Although temporary pacing is often preferred when possible, some patients receive permanent pacemakers before Lyme carditis is recognized.
In their study “Pacemaker Explantation in Patients With Lyme Carditis,” Wamboldt and colleagues describe two patients with Lyme carditis who later underwent successful pacemaker removal after recovery of normal conduction.
These cases highlight why clinicians should consider Lyme carditis in patients presenting with unexplained high-degree AV block, especially in endemic regions.
Case 1: Complete heart block and pacemaker placement
A 48-year-old woman presented with shortness of breath and dizziness secondary to complete heart block.
Because of symptomatic bradycardia, she was transferred to a tertiary care center for pacemaker implantation.
Three months before symptom onset, she had developed a nonspecific abdominal rash.
Lyme disease testing was positive.
The patient was treated with antibiotics and underwent follow-up evaluation after stabilization.
The authors concluded that pacemaker removal may be considered in selected patients after treatment if normal cardiac conduction returns.
Case 2: Atrial fibrillation, pauses, and Lyme carditis
A 58-year-old man presented with dizziness, syncope, headache, and myalgia.
His initial electrocardiogram showed atrial fibrillation with slow ventricular response.
During hospitalization, he developed symptomatic pauses lasting 4 to 10 seconds and underwent pacemaker implantation.
Lyme disease testing was positive.
Both patients responded well to antibiotic treatment and later underwent reassessment of conduction recovery.
Why pacemaker reassessment matters in Lyme carditis
Patients with Lyme carditis are frequently managed with temporary pacing strategies because cardiac conduction abnormalities often improve with treatment.
In these cases, permanent pacemakers had already been placed before recovery occurred.
On follow-up, both patients underwent exercise stress testing and maintained 1:1 conduction at heart rates greater than 120 beats per minute.
The permanent pacemakers were successfully removed.
The authors note that lead extraction success is generally higher and complications lower when removal occurs within the first year after implantation.
These findings reinforce the importance of close follow-up after treatment and ongoing reassessment of cardiac recovery in patients with Lyme disease symptoms involving the heart.
Can Lyme carditis mimic other heart conditions?
Lyme carditis may present with dizziness, syncope, palpitations, shortness of breath, chest discomfort, or conduction abnormalities.
Because these symptoms overlap with many cardiovascular disorders, Lyme carditis may initially be missed or mistaken for primary cardiac disease.
Prompt recognition and diagnostic evaluation remain important, particularly in patients with exposure risk or accompanying systemic symptoms.
Diagnostic challenges in Lyme disease extend beyond cardiology and may contribute to delayed Lyme disease diagnosis.
What are the limitations of these cases?
- This report describes only two patients
- These cases may not represent all Lyme carditis presentations
- Pacemaker removal decisions require individualized evaluation
- Not all patients recover conduction at the same rate
- Case reports cannot establish management guidelines
Frequently Asked Questions
Can Lyme carditis cause heart block?
Yes. Lyme carditis commonly causes AV conduction abnormalities, including high-degree heart block.
Do Lyme carditis patients always need permanent pacemakers?
No. Many patients improve after treatment and may only require temporary pacing support.
Can a pacemaker be removed after Lyme carditis?
Selected patients may be candidates for pacemaker removal after recovery of normal conduction and appropriate cardiac testing.
What symptoms suggest Lyme carditis?
Symptoms may include dizziness, syncope, palpitations, chest discomfort, shortness of breath, and fatigue.
How is Lyme carditis diagnosed?
Diagnosis involves clinical history, Lyme disease testing, ECG findings, and evaluation for conduction abnormalities.
Clinical Takeaway
Lyme carditis should remain part of the differential diagnosis for patients presenting with unexplained conduction abnormalities or heart block.
These cases demonstrate that cardiac conduction may recover after treatment, making reassessment important before assuming permanent pacing will always be required.
Related Articles
These articles explore Lyme carditis, heart block, diagnostic challenges, and cardiac complications associated with Lyme disease.
Can we avoid using a pacemaker for Lyme carditis with high degree AV block?
Lyme disease and the heart when AV block progresses rapidly
Mitral valve dysfunction from Lyme carditis
Lyme disease misdiagnosis
Recovery from Lyme disease
References
- Wamboldt R, Wang CN, Miller JC, Enriquez A, Yeung C, Chacko S, Foisy M, Baranchuk A. Pacemaker Explantation in Patients With Lyme Carditis. JACC Case Rep. 2022;4(10):613-616.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
